Hypertension affects 85 million individuals, and 1 in 3 adults have high blood pressure in the United States. Blood pressure is the force of blood pushing against the walls of the arteries which carry blood from the heart to other parts of the body. In the United States, Hypertension is considered to be the most common primary diagnosis and reason for office visits. In addition, the prevalence is high, nationally and worldwide. In this article, we will identify Hypertension, briefly discuss causes, types, complications, and treatments.
The American Heart Association defines Hypertension as the following:
Normal blood pressure: systolic < 120 mmHg and diastolic < 80 mmHg
Elevated blood pressure: systolic 120-129 mmHg and diastolic < 80 mmHg
The European Society of Hypertension defines Hypertension as a systolic 140mmHg or diastolic 90mmHg.
Stage 1 - Systolic 130mmHg - 139 mmHg or diastolic 80-89mmHg
Stage 2 - Systolic 140mmHg or Diastolic 90mmHg
There are three important factors required to diagnose Hypertension:
1. A proper measurement technique
2. The integration of blood pressure measurement both at home using ABPM and clinical based readings
3. A mean average calculated from taking multiple readings in order to accurately confirm the diagnosis
Types of Hypertension
1. Primary Hypertension: unknown cause
2. Secondary Hypertension
3. Pregnancy induced Hypertension
How to properly measure the blood pressure
Proper size cuff at mid-arm
Sit with back supported
Do not speak
Rest arm at heart level
Blood pressure should be measured in both arms and mean number should be taken
Primary (essential) Hypertension is the most common type. It is affected by cardiovascular and renal structure and function. Secondary Hypertension is caused by other conditions like tumors, hormonal dysfunction, structural anomalies, and pregnancy.
Risk factors of Hypertension
Age: advancing in age increases the risk of Hypertension
Using tobacco: smoking tobacco and chemicals in tobacco both causes damage and narrowing to the arteries
Obesity: obesity and weight gain is a major contributing factor
Family history: Hypertension is twice as common in individuals who have hypertensive parents. This could be related to genetics. Race also plays a role where Hypertension is higher in African Americans
High sodium diet: excess sodium intake (>3g/ day sodium chloride) increases the risk of Hypertension
Excessive alcohol consumption
Physical activity: sedentary life style can cause Hypertension while increase in physical activity plays a major role in decreasing the blood pressure
Medication: cold medicine and decongestants (phenylephrine and pseudoephedrine), oral contraceptives especially those with high estrogen, NSAIDs like ibuprofen, naproxen, especially for long use, steroids, some weight loss medication, antidepressants, stimulants like ADHD medications and some other antipsychotics and finally illicit drugs like methamphetamines and cocaine
Obstructive Sleep Apnea: Hypertension is reversible once apnea is treated
Coarctation of Aorta, Cushing’s syndrome, thyroid diseases
Pregnancy induced Hypertension, related to pregnancy period and in most cases, blood pressure normalizes after child birth
Most people with high blood pressure have no signs or symptoms even if blood pressure readings are high. It is discovered while doing a routine checkup or seeing a physician for an unrelated complaint. Few people may experience headaches, shortness of breath, nosebleeds, chest pain, flushing, or they are presented with life threatening emergencies.
Complications of Hypertension
Persistent untreated high blood pressure and or sudden rise in blood pressure can lead to the following complications:
Left ventricular hypertrophy
Aneurysms and ruptured aneurysms
Ischemic and hemorrhagic stroke
Chronic kidney disease
Impaired memory and dementia
Life style modifications should be initiated with all patients such as: salt and sodium restrictions, smoking cessation, increase physical activity, avoiding over use of pain medication, minimizing alcohol consumption and weight management.
Medications are used to decrease and or prevent complications of Hypertension. It is not uncommon to use more than one medicine to achieve maximum control. Antihypertensive medications are: diuretics like HCTZ or Chlorthalidone, calcium channel blockers like Amlodipin, ACE inhibitors like Lisinopril or Ramapril, ARBs like Losartan and Valsartan, beta blockers as an add on like Atenolol and Metoprolol, other medications are also available.
In conclusion, Hypertension is a silent killer as it is often a symptomatic, therefore, annual. Being physical and paying attention to abnormal signs and symptoms in our body is important to diagnose and treat this disease. The ultimate goal of therapy is to reduce cardiovascular events and end organ damage.
Nada Hana Bachuri, MD is a doctor at Ascension Providence Rochester Hospital and Troy Family Care.